Hidradenitis Suppurativa

Definition

This is a chronic skin inflammation characterized by the presence of blackheads and one or more red, tender bumps or lesions. In most cases the lesions enlarge, break open and drain pus. After several recurrences, scarring may result.

Hidradenitis suppurativa develops deep in the skin around oil (sebaceous) glands and hair follicles. It is considered a severe form of acne and the parts of the body that are usually affected are also the main locations of apocrine sweat glands, such as the armpits and the groin.

This skin condition usually starts after puberty, persists for years and worsens over time. To help manage the symptoms and prevent new lesions from developing, hidradenitis suppurativa should be diagnosed and treated early.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

As mentioned before, hidradenitis suppurative usually occurs in the armpits, groin and anal area, which means that it occurs around hair follicles where many oil and sweat glands are found. This condition can also occur under the breasts, on the inner thighs, between the buttocks or any other area where the skin rubs together. Either a single area or multiple areas could be affected by hidradenitis suppurativa.

Some of the signs and symptoms of this condition may include:

Painful, pea-sized lumps that grow under the skin. These hard lumps can enlarge and become inflamed. They usually persist for years.Small pitted areas of skin that contain blackheads, which usually appear in pairs, or a "double-barrel" pattern.Painful bumps or sores that continually leak fluid. Usually, these open wounds heal very slowly, if they heal at all, and lead to the development of scarring and tunnels under the skin.One or more red, tender bumps or lesions that fill with pus. These bumps enlarge, break open and drain pus, which could have an unpleasant odor. The bumps may be accompanied with itching, burning and excessive sweating.

In most cases, this condition starts at puberty with a single, painful bump that persists for weeks or months. In some cases, the disease could progressively get worse and affect multiple areas of the body. Some people may experience only mild symptoms. Some of the factors that could make the symptoms worse include:

Stress

Excessive perspiration

Excess weight

Hormonal changes

Heat

Self-care measures could usually treat mild cases of this disease. However, a person should consult a doctor or a dermatologist in case their condition doesn't improve in one or two weeks, recurs often, is painful or appears in several locations. In most cases, in order to manage the problem, the person will need medical treatment, such as prescription medications or surgery.

Causes:

As mentioned before, this condition occurs deep in the skin around sebaceous or oil glands, apocrine sweat glands and hair follicles. The apocrine sweat glands release fluid into the hair follicle as well as dead skin cells and other substances that mix with the oil from the sebaceous gland. When the oil glands and hair follicle openings become blocked with these substances, hidradenitis suppurativa occurs, and when oils and other skin products become trapped, they push into surrounding tissue. Infection and inflammation could be triggered by bacteria.

The exact cause of this blockage is still not known. However, some factors are thought to play a role such as excess weight, hormones, cigarette smoking and genetics.

In some cases, this condition may accompany herpes simplex, Crohn's disease, Grave's disease or other diseases.

Complications

Complications:

When hidradenitis suppurativa is persistent and severe, it usually causes complications such as:

Scars and skin changes:
Thick, raised scars, pitted skin or patches of skin that is darker than normal (hyperpigmentation) could be caused by severe hidradenitis suppurativa.

Sinus tracts or tunnels that connect and form a network under the skin:
These tracts will cause more sores to develop and will prevent them from healing.

Cellulitis:
This condition is a potentially serious bacterial infection that appears as an area of swollen, red skin that feels hot and tender and may spread rapidly. The infection could eventually affect the underlying tissues of the skin or spread to the bloodstream and lymph nodes, despite the fact that the initial infection is usually superficial.

Restricted movement:
Particularly when this disease affects the armpits or thighs, it could cause limited or painful movement.

Treatments:

Although early treatment could help manage the symptoms of hidradenitis suppurativa and prevent new lesions from developing, this disease has no cure.

Whether the sores are painful or infected as well as the extent of the affected areas will determine the treatment. Self-care measures such as regular washings with antibacterial soap and warm compresses could treat the mild cases. However, topical or oral medications may be required in treating moderate cases. Some of the medications that could be used include:

Antibiotics: These are used to treat infection. Future outbreaks or worsening of the disease could be prevented in case antibiotics are taken for a long time in the early stages of the disease.

NSAIDs: These medications could reduce swelling and pain.

Immunosuppressant drugs or corticosteroids

Oral retinoid medications: These medications are taken to prevent the plugging of the hair follicle and to stop oil gland functions.

Surgery may be necessary for severe or persistent cases of the disease. Some of those surgical procedures may include:

Uncovering the tunnels or tracts:
The scarring could be minimized and the healing of the lesions increased by cutting away skin and flesh that cover any tunnels or tracts. However, this procedure does not prevent the disease from returning in another area of the body or even in the treated area.
Incision and drainage:
When the disease occurs in a single small area, one of the available options could be the surgical drainage or removal of the lesions. This treatment is usually used for short-term relief and it doesn't prevent the disease from returning.

Surgical removal:
Full surgical removal of the affected areas could treat the disease that is present; however, it doesn't prevent the disease from occurring in other areas. This procedure is used when the symptoms are recurrent or severe. In this procedure, all of the involved skin will be removed, followed by direct closure with skin flaps or with skin grafting, which is when skin is removed from one area of the body and attached to another area.

The chances of the recurrence of this disease even after surgical treatment are increased because of obesity, ongoing skin infections and incomplete removal.